Lyophilized xenograft: a case series of histological analysis of biopsies

Abstract

The reconstruction of an acetabular bone defect is one of the most important aspects of revision total hip arthroplasty surgery. It can be done by the use of grafts. Therefore, many kinds of grafts may be used and lyophilized xenograft is an alternative example. The purpose of the study was to evaluate the histological findings of lyophilized bovine xenografts used in previous total hip arthroplasty revision surgery. A case series was carried out from July 2000 to April 2013 with the approval of the Hospital Ethics Committee. Fourteen subjects were analyzed. Of these, 64.3 % were female. The average age of the patients was 52.36 ± 18.55. Neoformed bone was present in 85.7 % of subjects, and constituted 61.79 % of the total bone matrix area. The diagnosis of xenograft absorption was present in 12 subjects. A strong inverse correlation between the percentage of neoformed bone and the percentage of xenograft in the total bone matrix by analysis of biopsies was found by the Pearson test (p = 0.001). No inflammatory response was found in the clinical status of the patients or in the histological analysis. Lyophilized bovine xenograft shown to be safe until the present moment, with acceptable results. Most of the cases presented new bone formation as expected (considered values greater than 30 %) and for this reason the xenograft has proven to be an osteoconductive compatible scaffold/trellis for the bone ingrowth. Therefore, it can be considered an alternative to other bone grafts in the treatment of bone loss.

Biology of Bone Graft and the Use of Bovine Bone for Revision of Total Hip Arthroplasty with Acetabular Reconstruction

“…The lyophilisation process until now has not been linked with infection as confirmed by Shibuya et al [48], Ledford et al [29] and Ribeiro et al [44] who also reported no clinical signs of infections in patients submitted to revision of total hip arthroplasty with acetabular reconstruction, as well as no case of bovine spongiform encephalopathy disease (BSE) and its new variant the Creutzfeldt-Jakob disease (CJD). It is believed that lyophilisation process chemically inactivates most of the bacterial agents, viral and prion agents to a safe and acceptable level to be used in humans as reported by Wenz et al [63] and among us, by Galia et al [16] and Rosito et al [45].…”

“…Buma and colaborators detailed Galia [14] in their PhD thesis, in 2000 and 2004 (Figures 1 and 2), respectively, demonstrated the relationship between time elapsed from grafting till to biopsies for histological analysis. The wider the interval, the larger the amount of new bone formation and the smaller the residual bone graft, though Tiango et al in 2015 [44] in a case series resulted from his PhD thesis was notable to reconfirm these findings, probably due to the small number of cases with biopsies in the study [5,17,18,58]. Out come in bone transplantation also depends on antigenic reaction factors.…”

“…The use of transplants in orthopaedic surgeries has become essential in many situations in which there is a bone defect. This includes bone tumour procedures, fracture operations where there was a loss of bone tissue and revision arthroplasty surgeries [11,44,53]. The latter, revision arthroplasty, has considerably increased since the rate of primary arthroplasties has grown substantially in recent years.…”

“…Some kind of musculoskeletal tissue is transplanted into 10 to 15% of orthopaedic surgeries performed in the United States. Annually, about 650,000 bone-based grafts are distributed by the American Tissue Banks, clearly highlighting the importance of processing, controlling and storing of this type of material becoming one of the major transplanted tissues [44,59].…”

“…Deep-frozen homologous graft is the most common used bone graft, but its use is limited due to shortage and although small, the risks of transmitting contagious diseases and even cancers should not be overlooked [11,44]. On the other hand, though homologous lyophilised (freeze-dried) grafts have virtually eliminated the risk of transmissible diseases is still lacking availability and therefore, alternative biomaterials from synthetic or natural source have been considered and carefully studied.…”